[Ultrasound-guided percutaneous insertion of implantable venous devices: a review of 102 patients]. / Pose de chambre implantable par abord percutané échoguidé : à propos d'une série de 102 patients.

Techniques of insertion of implantable venous devices have been widely described. The use of ultrasound guidance is part of the good practice recommendations of the SOR 2008 but there are few data in the literature and recommendations are based only on expert agreement. To this end we conducted a prospective, single-center study from January 2008 to August 2009 on percutaneous ultrasound-guided insertion of implantable devices. In addition to age, sex, the therapeutic indication and the site of implantation, we identified the operative time and number of venipunctures performed for each procedure. We then identified the infectious complications at three months and thromboembolic complications at 1 year and a half. Our study examined 102 consecutive patients. The mean age was 61.8 years (28-90); 71% of patients were men. For 101 patients, the internal jugular vein was punctured, the subclavian vein in one patient. In 86% of cases, the implantable venous device was inserted into the right vein. The average length of procedure was 30 minutes (18-60) for a single-vein puncture. Among the 102 patients, the overall morbidity was 7.8% with four infections (3.9%) and four thromboses (3.9%). There were no immediate perioperative complications (arterial puncture, hematoma, pneumothorax). In conclusion, percutaneous ultrasound-guided insertion of implantable venous devices in the internal jugular vein is a safe, minimally invasive technique which complies with the 2008 SOR recommendations by preventing the risk of venous thrombosis and avoiding repeated venous puncture. Less invasive than the open surgical approach, ultrasound-guided insertion is safer than puncture based solely on anatomical landmarks. In summary, this is a reliable, simple and easily reproducible technique which limits iatrogenic risks and improves patient comfort.

French experience in the management of hemorrhoids by HAL™ Doppler.

OBJECTIVE: The goal of this study was to prospectively evaluate the surgical management of hemorrhoids by Doppler-guided hemorrhoidal artery ligation (Doppler HAL™). PATIENTS AND METHODS: This study was conducted between April 2008 and September 2009. The Doppler HAL™ technique was performed in patients with grades II to IV, irrespective of whether they had previously undergone medical or instrumental management or not. The other demographics of the studied population, the operative and post-operative results as well as the functional outcome at one month and at one year were recorded prospectively and analyzed retrospectively. RESULTS: Sixty-one consecutive patients (mean age 45 [range 28-85]) underwent Doppler HAL™. The mean duration of operation was 26minutes [range 18-45]. The average number of ligations per patient was seven. Three patients left the hospital the same day, 51 patients were discharged on day 1 and five patients on day 2. Post-operative mortality was nil. The post-operative morbidity rate was 4.9%. Functional results evaluated at one month and one year showed that initial symptoms had disappeared in more than 78% of patients. The recurrence rate for hemorrhoidal related disease was 10.5% during the first year. CONCLUSION: Surgical treatment of hemorrhoids by the Doppler-guided hemorrhoidal artery ligation technique is mini-invasive, with low morbidity, and satisfactory short and medium term functional results. This technique represents a reliable surgical alternative to classical hemorrhoidectomy and hemorrhoidopexy in the therapeutic strategy of hemorrhoidal disease.

Superior mesenteric artery syndrome: a rare etiology of upper intestinal obstruction in adults.

The superior mesenteric artery (SMA) syndrome is an atypical cause of high intestinal obstruction in adults. Formerly considered controversial, this syndrome has now been recognized as a real clinical entity which results from extrinsic compression of the third portion of the duodenum by reduction of the angle formed between the SMA and the aorta, usually favoured by rapid and dramatic weight loss. We report a case observed in a 25-year-old female. The abdominal scan provided the diagnosis. Laparoscopic duodenojejunostomy provided cure after failure of initial conservative treatment.

[Recent injuries to the left diaphragm: value of laparoscopy in Africa and Europe]. / Lésions récentes du diaphragme gauche: intérêt de la laparoscopie, en Afrique comme en Europe.

Management of recent diaphragm injury is challenging. The purpose of this report is to describe two patients who presented injuries to the left diaphrgmatic cupola, i.e., rupture due to blunt trauma in Europe and a stab wound in Africa. The value of laparoscopy for diagnosis and treatment are discussed in these contrasting settings.

[Primary peritonitis in Sub-Saharian Africa: a 15 case series]. / Péritonites primitives en Afrique subsaharienne: à propos de 15 cas.

Primary peritonitis (PP) is an infection of the peritoneal cavity occurring in the absence of a documented intraabdominal source of contamination. It is one of the main infectious complications of cirrhosis but is rare in healthy subjects. The purpose of this retrospective study is to describe a series of 15 cases of PP treated over a 3-year period at the Principal Hospital in Dakar, Senegal. The patient population was young (all but 2 under age of 13 years) and predominantly female (87%) with no predisposing factors. Clinical presentation always involved typical peritonitis. Surgical exploration was performed in all cases by laparotomy (n=13) or laparoscopy (n=2). Intra-operative bacteriologic sampling was performed systematically. Probabilistic antimicrobial therapy was administered in all cases using a triple-drug combination including a cephalosporin or betalactamine, an aminoside and metronidazole. This unconventional combination was designed to allow low-cost wide-spectrum coverage. As in patients with cirrhosis, the most common microbial agents were gram-negative bacteria (47%). Streptococcus pneumoniae was identified in 40% of cases. Infectious ORL and pulmonary sites were suspected in some cases. Although no supporting bacteriologic evidence was obtained, the high frequency of pneumococcal involvement as well as the age and female predominance of the patient population is consistent with contamination via the female genital tract. The cases in this series present unusual epidemiological, clinical and bacteriologic features. In Europe surgical treatment can be avoided thanks to the availability of modern facilities to support further laboratory examinations. In Africa antimicrobial therapy and peritoneal lavage are the mainstay treatments. Use of laparoscopy should be expanded.

Peritonites primitives en Afrique subsaharienne : a propos de 15 cas

La peritonite primitive (PP) est une infection du peritoine sans etiologie septique intraperitoneale. Souvent decrite chez le cirrhotique; elle est rare chez le sujet sain. Nous rapportons une etude retrospective sur 3 ans de 15 cas pris en charge a l'Hopital Principal de Dakar. Tous les patients ont ete operes. Les prelevements bacteriologiques per-operatoires ont ete systematiques. La population etait jeune (2 patients avaient plus de 13 ans); de predominance feminine (87); sans terrain predisposant. Le tableau clinique etait toujours celui d'une peritonite. L'exploration chirurgicale a ete menee 13 fois par laparotomie et 2 fois par laparoscopie. Une triple antibiotherapie probabiliste completait systematiquement ce geste. Elle comprenait une cephalosporine ou une beta-lactamine; un aminoside et du metronidazole. Cette association peu commune permettait une antibiotherapie a large spectre peu couteuse. Les bacilles gram negatif etaient; comme chez le cirrhotique; les germes les plus retrouves (47). Streptoco- ccus pneumoniae a ete retrouve dans 40des cas. Des foyers infectieux ORL et pulmonaires ont parfois ete suspectes.Malgre l'absence de documentation bacteriologi-que genitale; la frequente implication de pneumocoque et l'age de la population evoqueraient une contamination par voie gynecologique chez les jeunes filles. Cette etude presente des aspects epidemiologiques; cliniques et bacteriologiques inhabituels. En Europe; la chirurgie peut etre evitee grace a l'accessibilite des examens complemen- taires de qualite. En Afrique; les bases du traitement reposeraient sur l'antibiotherapie et la toilette peritoneale. La laparoscopie serait la voie d'abord a privilegier

Peritonites primitives en Afrique subsaharienne : a propos de 15 cas

La peritonite primitive (PP) est une infection du peritoine sans etiologie septique intraperitoneale. Souvent decrite chez le cirrhotique; elle est rare chez le sujet sain. Nous rapportons une etude retrospective sur 3 ans de 15 cas pris en charge a l'Hopital Principal de Dakar. Tous les patients ont ete operes. Les prelevements bacteriologiques per-operatoires ont ete systematiques. La population etait jeune (2 patients avaient plus de 13 ans); de predominance feminine (87); sans terrain predisposant. Le tableau clinique etait toujours celui d'une peritonite. L'exploration chirurgicale a ete menee 13 fois par laparotomie et 2 fois par laparoscopie. Une triple antibiotherapie probabiliste completait systematiquement ce geste. Elle comprenait une cephalosporine ou une beta-lactamine; un aminoside et du metronidazole. Cette association peu commune permettait une antibiotherapie a large spectre peu couteuse. Les bacilles gram negatif etaient; comme chez le cirrhotique; les germes les plus retrouves (47). Streptococcus pneumoniae a ete retrouve dans 40des cas. Des foyers infectieux ORL et pulmonaires ont parfois ete suspectes.Malgre l'absence de documentation bacteriologique genitale; la frequente implication de pneumocoque et l'age de la population evoqueraient une contamination par voie gynecologique chez les jeunes filles. Cette etude presente des aspects epidemiologiques; cliniques et bacteriologiques inhabituels. En Europe; la chirurgie peut etre evitee grace a l'accessibilite des examens complementaires de qualite. En Afrique; les bases du traitement reposeraient sur l'antibiotherapie et la toilette peritoneale. La laparoscopie serait la voie d'abord a privilegier

[Appendicectomy in the tropics: prospective study at Hôpital Principal in Dakar]. / Appendicectomies en milieu tropical: étude prospective à l'Hôpital Principal de Dakar.

Acute appendicitis is the most common surgical indication in Africa. It is associated with higher mortality and morbidity than in industrialized countries. The purpose of this prospective 100 case study was to evaluate diagnostic, clinical and paraclinical features as well as surgical modalities especially with regard to approach and postoperative recovery in patients that underwent surgical treatment for appendicitic syndromes over a 9-month period at our institution. Analysis of study data confirmed that surgical indications could be established based on clinical examination alone and that adjuvant investigations only delayed therapy while providing little specific, useful information. Delayed management is a specific feature of tropical areas. Surgical exposure was achieved by the MacBurney approach in 65% of cases, celioscopic approach in 18%, and median laparotomy in 17%. The benefit of the celiosocopic approach was statistically signicant in terms of resumption of eating, duration of hospitalization and incidence of postoperative complications. Mortality in this series was 0% and morbidity was 7% mainly due to parietal complications.

[Kidney cancer in horseshoe kidney. A case report of an unexpected diagnosis]. / Cancer sur rein en fer à cheval. A propos d'un cas de découverte fortuite.

The authors report a case of renal cell carcinoma in a horseshoe kidney and discuss diagnostic and therapeutical aspects arising from this combination. Renal carcinoid tumors and nephroblastoma seems to be more frequent in this malformation. Diagnosis of horseshoe kidney may be difficult and angiography examination is very useful to confirm renal anomaly, tumor situation, and to plan the surgical approach because vascularization vary case to case. Heminephrectomy adapted to neoplasic localisation remains the essential treatment.

[Unusual testicular tumor: an ectopic spleen]. / Tumeur testiculaire inhabituelle: une rate ectopique.

The authors report a case of discontinuous splenogonadal fusion diagnosed after left orchidectomy. Ectopic spleen in the scrotum is a rare congential anomaly frequently associated with other anomalies, especially limb defects. The diagnosis is difficult. Preoperative isotope scanning and intraoperative pathological examination can be performed to avoid unnecessary orchidectomy.

[Oriental biliary lithiasis. Retrospective study of 690 patients treated surgically over 8 years at Hospital 108 in Hanoi (Vietnam)]. / Les lithiases biliaires extrême-orientales. Etude rétrospective sur 690 patients opérés en 8 ans d'activité à l'Hôpital 108 de Hanoi (Vietnam).

The purpose of this study was to review the unique features distinguishing Oriental from Western gallbladder disease based on a series of 690 patient who underwent surgical treatment at hospital 108 in Hanoi. Oriental cholangiohepatitis often affects in young patients with no gender predilection. The disease originates mainly in canaliculi and leads to blockage or obstruction of the main bile duct inside and outside the liver. Onset has been related to nutritional, infectious, and parasitic factors. Ascariasis may play a determinant role. Because of these unique features, surgical treatment is usually focused on the main bile duct and depends on the size, number, and effects of gallstones. The authors recall that excision of liver tissue may be unavoidable in some cases due to the severity and consequences of lithiasis.

[Port-site metastases following laparoscopic surgery]. / Métastases orificielles après coeliochirurgie.

Laparoscopy for malignancy resection has been followed by description of metastatic laparoscopic port sites. Recently published clinical, experimental studies and case reports related to this problem are reviewed. Frequency of port-site metastases for gallbladder, colorectal and ovarian cancers seem to differ. Ascites and staging during laparoscopy are probably risk factors for port-site metastases. Clinical presentations of port-site metastases are exposed and experimental studies show that pneumoperitoneum, nature of gas as well as local factors were probably implicated. Hypothetical mechanisms of port-site metastases are discussed; it is likely that the aetiology are multifactorial. Preventive strategies of port-site metastases are proposed. Further research in this area is necessary to understand mechanisms of port-site metastases.